Some reflux symptoms hard to treat

NEW YORK (Reuters Health) - Popular drugs for treating acid reflux are more effective at treating some symptoms than others, a new study finds.

Specifically, the acid-suppressing drugs such as Prilosec and Prevacid are better at treating heartburn than regurgitation, in which fluid from the stomach rises up into the back of the mouth, often when bending over or wearing tight clothes. The fluid often contains stomach acid, creating a bitter taste.

The popular drugs, known as proton-pump inhibitors (PPIs), "work much better for heartburn than for regurgitation," study author Dr. Peter Kahrilas of Northwestern University told Reuters Health.

The conclusion, based on an analysis of previous research looking at PPIs in reflux, is not a surprise, Kahrilas noted.

"Heartburn is caused by acid in the esophagus and relieved by neutralizing that acid," he explained. "PPIs eliminate acid. Regurgitation can still happen without acid so even though the bitter taste may be improved by PPIs, the unpleasant symptom continues."

It's not uncommon for patients to report that a PPI takes care of the burning in their chest, but they still taste bitter fluid after meals, noted Dr. Joel Richter at the Temple University Department of Medicine, who did not participate in the research.

But true regurgitation affects only 20 to 30 percent of people with heartburn, Richter told Reuters Health. For people with this "much less common symptom," often surgery (to tighten the passageway between the esophagus and the top of the stomach) is the solution, he noted. "Bad acid regurgitation is a mechanical problem and the PPIs are unlikely to be a cure-all," he said in an email.

Alternatively, people can minimize regurgitation by eating smaller means, not exercising after eating, and avoiding clothing that's tight around the midsection, Kahrilas advised.

The current study, published in the American Journal of Gastroenterology, reviews the results from 31 large studies examining the effectiveness of PPIs for gastroesophageal reflux disease, or GERD.

Not all trials evaluated regurgitation in the same way. Focusing on 7 trials in particular, the researchers found that people said their regurgitation improved only marginally better with PPIs than with a placebo (inactive) drug, and the proportion of those whose regurgitation responded to PPI treatment was at least 20 percent less than the heartburn response rate.

Many of the trials did not focus on regurgitation when evaluating PPIs, likely because it's harder to measure than heartburn and other symptoms of GERD, explained Kahrilas in an email. Scientists also aren't always consistent in their definition of regurgitation, "making it understood in different ways even among experts."

PPIs, which suppress stomach-acid production, have names like omeprazole (Prilosec), lansoprazole (Prevacid) and esomeprazole (Nexium). Prilosec and Prevacid are both available over the counter, and typically cost about 50 cents per pill. Nexium is still only available by prescription, and is more expensive.

Kahrilas and his co-author have both acted as consultants for pharmaceutical companies, including those that market PPIs. Study author Dr. Nesta Hughes is an employee of Oxford PharmaGenesis, a communications consultant for the pharmaceutical industry.